For the Physician

The following checklist has been developed to serve as a guide to help you determine whether or not a patient is eligible to receive home health care services. Patients are eligible for a certified home care agency referral and services when any of the following apply to them...

1. Have a complex medical need, such as:
   • a new diagnosis.
   • exacerbation of an existing illness (COPD, CHF, Diabetes).
   • home infusion agency.
   • multiple diagnoses.
   • pain management.
   • wounds.
2. Are at risk for problems due to:
   • a history of falls.
   • a history of multiple hospitalizations or ED visits.
   • being elderly & living alone.
   • de-conditioning related to hospital stay.
   • new, multiple or changed medications.
   • poor understanding of diseases and symptoms to report to MD.
3. Require skilled nursing treatment at home, such as:
   • blood draws from central lines.
   • catheter care and routine changes.
   • central line care and maintenance.
   • dressing changes for wound care.
   • enteral feedings and tube care.
   • Injections.
   • ostomy care and teaching.
   • teaching related to medical condition.
   • tenkoff catheter care and drainage.
4. Recently had surgery or a long hospitalization, and:
   • are at risk for complications or infection.
   • are concerned about safety at home.
   • need assistance of Aide for personal care and ADLs.
   • need assistance setting up other community resources.
   • need instruction in symptoms to report to MD.
   • need therapy to resume previous function.
   • require initial monitoring at home.

The certified home care agency must determine whether services can be delivered safely at home. Some conditions that affect safety, and therefore eligibility for home health care are:

1. cannot walk or transfer safely & will be home alone.
2. require 24-hour care and/or supervision & have no adequate caregiver.
3. exhibit behavior that would place a provider at risk.
4. "other" – as determined through assessment.